Everything you need to know about heartburn today to avoid future complications

Health Tips

Heartburn – a frequent “companion” of pregnant women – occurs in 25-80% of cases during pregnancy. The frequency and intensity of symptoms depend on the duration of pregnancy, usually they completely disappear after childbirth. Heartburn begins to bother pregnant women from about 20-22 weeks, occurring periodically. From the 30th week, a third of all expectant mothers complain of heartburn and associated discomfort, and by the 38th week their number grows, according to various authors, up to 98%. Heartburn and other signs of gastroesophageal reflux (GERD) get worse with age.

The reasons

The cause of heartburn is the reflux of acidic contents of the stomach into the esophagus, this phenomenon has a medical name – gastroesophageal reflux, which occurs in almost half of the country’s population. It is difficult to meet an adult who has not experienced this feeling at least once in his life. Reflux can be caused by functional insufficiency of the lower esophageal sphincter (valve – ed. note), hernia of the esophageal opening of the diaphragm, shortening of the esophagus, etc. These reasons will help determine the doctor.

Effects

In addition to unpleasant sensations, acid, getting from the stomach into the esophagus, causes reflux esophagitis – inflammatory changes in the esophagus against the background of irritating action of gastric juice. In the absence of proper treatment, severe forms of esophagitis can develop, complicated by bleeding, cicatricial strictures, or the development of gastric metaplasia of the epithelium – Barrett’s esophagus, which can later transform into esophageal cancer.

Diagnostics

If symptoms such as heartburn, belching of air, burning sensation behind the sternum appear, which increase after eating, it is necessary to contact a team of specialists, including a gastroenterologist and a surgeon.

In the diagnosis of gastroesophageal reflux, the following are used:

– esophagogastroscopy (FGDS – “swallowing” the probe) to assess the condition of the mucosa of the esophagus and stomach, the condition of cardiac sphincter, identify indirect signs of hiatal hernia, – X-ray examination of the esophagus, stomach with barium to detect reflux, hiatal hernia and shortening of the esophagus, – if necessary, use daily pH-metry (measurement of the acidity of the stomach or duodenum using a probe). This allows you to identify and eliminate the causes of reflux and begin treatment.

Treatment

For most patients, taking antisecretory drugs is enough to eliminate the causes of heartburn. A complex of conservative and preventive measures allows achieving good results in 65-80% of patients with mild to moderate reflux esophagitis. There are patients for whom the most modern schemes of conservative (drug) therapy provide only a short-term effect and do not prevent the development of complications. A large number of studies suggests that remission of the disease is possible only in 70% of patients, subject to lifelong use of antisecretory drugs, and at least 15% of patients require surgical treatment.

Surgical treatment is indicated for:

  • failure of conservative therapy;
  • severe reflux esophagitis;
  • hiatal hernia with reflux esophagitis;
  • shortening of the esophagus.

The operation of choice in this case is a fundoplication, which consists in creating an extended symmetrical cuff from the cardiac section, the fundus and the body of the stomach, formed like a “tumbler glass”. If necessary, the operation can be supplemented with posterior crurorrhaphy, selective proximal vagotomy. These are laparoscopic operations – that is, minimally invasive, which are done through small incisions. They are performed under general anesthesia.

This type of antireflux operation gives good functional results with the disappearance of clinical symptoms in 92% of patients. A timely operation performed by a team of experienced specialists, using endoscopic equipment in a planned manner, leads to a significant improvement in long-term results and an increase in the quality of life of patients.

Photo: Vostock Photo

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